A Step-by-Step Guide to Managing the Educational Crisis: Lessons Learned from COVID-19 Pandemic.

BACKGROUND: Medical education is facing great challenges and uncertainties amidst the COVID-19 pandemic. AIMS AND
OBJECTIVES: This article aims to provide tips that can provide a guide for medical education leaders to coordinate crisis management referring to the Egyptian context.
MATERIALS AND METHODS: This work was done using a reflection on the COVID-19 response by Egyptian universities and analysis of such responses.
RESULTS: Medical Education Institutions are required to build a taskforce team for crisis management. These should be committed to supporting sudden online education transition, academic support, and the psychological well-being of students, staff members, health care professionals, paramedics, and faculty administration. As the situation evolves, the taskforce has to monitor the challenges and provide appropriate plans, guidance, and solutions. Leaders in medical education have a crucial role in response to the pandemic crisis in securing a successful educational process while ensuring the mental and psychological well-being of the stakeholders.
CONCLUSION: Crisis management is the skill of the future and more investment needs to be placed in designing crisis response and in enabling universities to accommodate this response. Copyright:

INTRODUCTION

COVID-19 pandemic has been a major disruptor for medical education worldwide. However, it can be considered as an opportunity for developing innovative methodologies. Hereby, we are forced to rely on technology enhanced learning.[1] During crisis situations, medical educators' ethical responsibilities to act as effective leaders have come into sharper focus more than ever. They must be mindful of their own, institutional, and stakeholders' strengths and weaknesses. Teamwork is essential to the open discussion about the challenges and concerns on facing the pandemic. Medical educators are required to take innovative steps to build online programs and curricula through strategic planning.

Whatever your position is in your institution, administrative, coordinator, head of a committee, head of a department, or module coordinator, you should have a vision towards planning a response for crisis management. The senior leader must transmit a sense of urgency, unify work teams, and prioritize the goals.

This work aims at offering a guiding document with tips to help people in responsibility manage their response to future crises effectively.

Dissecting the Egyptian response to the educational crisis (A case study)

With the beginning of this crisis, and although the world was shutting down 2 months before Egypt, yet once there was a declared lockdown in mid-March, all decisions started hailing down a top-down pipeline that materialized in the form of a number of decisions that started from complete shutdown of all educational activities without further notice. These decisions were revised every 15 days and with the second announcement, online learning started with no specific format announced to schools. The Ministry of Higher Education started investing in the purchase of equipment and software to facilitate communication with faculty. At that point of time, all universities already had full license on many programs that existed, but there was very limited use of prior to the shutdown, like Microsoft teams. Companies started putting in offers and negotiations started for purchase. Educational transformation started on ad hoc basis with initiatives that started from large schools in Egypt with a decision to start uploading recorded lectures for students with very little thought given on adapting the content to suit the new interphase. With this being in process, student attendance was considerably low for a multitude of reasons,[2] most importantly the fear of the students and their families to get exposed to the infection and the uncertainty about the whole situation. Another reactive procedure started assessing the possibilities of halting teaching all together for the term, delaying exams, changing exam formats, etc. All these discussions were held in the open and in public and resulted in a large wave of rejection that started from students and was complimented with faculty disengagement and stress.[2]

The impact of the chaotic transformation will affect the learning of students for years to come and lay a large amount of stress on decision makers, faculty, and students. Many questions are raised as how to be ready for future adaptations that seem to be the virtue of the coming era.

A recipe for future transitions

Considering the failure, lessons learned for the future to guide what needs to be the plan for transition are offered in the following section [Figure 1].

Figure 1

Crisis response algorithm

Strategize on crisis management

During the crises and trouble times, higher education institutions must plan strategically to face different types of risks.[3] Risks must be anticipated, and risk mitigation plans must be put into action once the institution is exposed. Health professions education institutions are in special need to have such strategic plans because of the unique nature of the subjects they teach, which require immediate actions to guarantee the delivery and assessment of skills-related learning outcomes. Plans should include proposed actions to address the undelivered and compromised learning outcomes and the way in which they will be compensated for in the future. An example would be compensation for missed clinical competences of clerkship years in the internship year under the supervision of the institution. Other options also need to be discussed, anticipated, and mitigated in the plan such as alternatives for assessment, communication venues, and engagement strategies. Leaving this unattended and managing it during the crisis will result in mixed messages that will lower the compliance and adherence to the plan.

This plan has to be an investment of all educational institutions in advance. The presence of this plan has always been an accreditation requirement for all schools. Although most medical schools in Egypt are accredited, these plans when needed did not emerge to the surface at all. This just indicated the twisted understanding of accreditation standards and their use on the ground[4] in the sense that sometimes the accreditation standards are used just as a template for completing the required “paperwork” for getting accredited, not as a guide for implementing best practices especially when dealing with crises.

Build response teams

Build a team for each response scenario assigning individuals using their job description and posts rather than their names. This team's plans/decisions should grant a fast track to the decision-making and executives' bodies within the institute with a clear policy that contains a time frame for approving its decisions and putting them into action.[5] Teams should contain members based on the scenario yet most probably including:

Heads of departments

Director of Education

Director of assessment

Data collection team (from the quality assurance unit)

Student body representative (more than one body should be represented and make sure you have a balanced student representation)

Communication team (including media spokesperson)

Psychiatric support team with trained students who can provide peer support in the times of crisis

Conflict resolution committee

Documentation team

External members to be added to the response team based on the nature of the crisis encountered.[6]

In the Egyptian chapter, there was a designated response team that was assigned centrally to keep the top management informed. Inside universities no teams were assigned. The response became the sole responsibility of school administration in its precrisis format. This resulted in a large workload and an unprecedented number of sicknesses that were reported among faculty administration in medical schools.[2] Many areas were left missed and unattended to like student psychological and social support that resulted in a large gap in communication between students and administration.[2]

Communicate effectively

Stakeholder analysis and mapping: understanding the internal and external stakeholders is a crucial step in managing the educational crisis situation. This will be a steppingstone towards identification of methods of communication and towards satisfaction of imminent needs of individuals and organizations affected by or affecting the situation

Design of a communication strategy: this is a document that identifies methods by which the stakeholders will be kept up to date with all the implementation steps taken. This document is expected to set guidelines for methods of communication, structure, and expected outcomes from each method. In addition to this, a time plan can be added to this strategy document offering a complete plan. Many methods of communication can be used including applications such as WhatsApp for rapid feedback and prompt corrective action[6]

Assign the communication strategy to a taskforce: This is a very important step to ensure the communication plan becomes the responsibility of a team. They will be responsible for timely implementation of the identified communication methods as per the identified time plan

Launch the communication plan considering

Communicating the vision-sense of urgency-to the decision makers (Dean)

Communication with the stakeholders inside and outside the institution

Communicating the vision to the visionary heads of departments

Transmission of the vision to the staff members (growth of the alliance).

Transmission of the vision to the supporting bodies of medical education (e.g., the Supreme council of Universities, Medical education sector, Other Medical schools, etc.)

Manage the relationship with the media: The relationship with the media will define how smooth the crisis resolution will be performed.[6] Media messages are identified and approved in a hierarchical fashion and approval of all media messages is the responsibility of the communication team, when managing the relationship with the media take care you need to:

Provide a platform for daily communication

Ensure accessibility for all the students and staff members

Set an announced agenda for media encounters.

Mobilize existing contingency plans

Assess the available contingency response plan[6]

Assign a review committee

Map the strengths and weaknesses in the system

Score the plan based on the threat grade of the situation; can be done through a rubric used by evaluators that contain checklist evaluations based on evaluated areas and indicators [Table 1]. The rubric card can also contain an open-ended item column for suggested reform areas and possible solutions.

Table 1

Template evaluator contingency plan rubric

Contingency plan subset	Accepted	Rejected (needs elimination)	Suggested correction
Objectives	Smart?	Mark only if the subset needs to be redesigned	Write down the recommended change if any
Methods	Is it the best plausible most convenient method to target?	Mark only if the subset needs to be redesigned	Write down the recommended change if any
Evaluation	Are the questions asked answerable? Will there be sufficient evidence to back up?	Mark only if the subset needs to be redesigned	Write down the recommended change if any
Communication plan	Are all plans for communicating with teams and stakeholders in place? Are they feasible? Do they need adaptation based on current situation?	Mark only if the subset needs to be redesigned	Write down the recommended change if any

Redesign the plan based on needs of the incident

Outline the action steps based on the identified strengths and weaknesses and the possible solutions found in the evaluator scorecard responses

Action steps should include both the academic and the nonacademic concerns

Special focus should be given to hospital related educational issues and the action steps taken that concern hospital administration and/or patients.

Kick off the contingency plan in a meeting with task leaders

Map deliverables and milestones and map out the decisions needed to be made in the next 15 days, 30 days, 60 days, and 90 days.

Engage students in every step

An open channel between the staff coordinators and students' representatives should be available (preferably WhatsApp for rapid feedback)[7]

Regular meetings with the students' representatives to communicate the vision, the implemented plan, and strategies

Engage the students in the process to acquire a sense of ownership for the implemented plan

Receive regular feedback for prompt corrective actions

Keep an eye on the vulnerable groups.

Lower-income students who struggle internet accessibility should be identified and proactively supported

Students that have been already academically struggling should be identified and receive extra support

The international students have additional concerns including obstacles to return home, accommodation, internet access, social, and academic struggles. Continual communication with the international students' representatives is essential to solve their issues.

In the Egyptian Response student groups like the IFMSA (https://ifmsa.org/) took the lead in all organized response against all university decisions. They built up a coalition against all government decisions related to medical education and pushed the student opinions against having examinations held online.[1]

Align for consensus and decision-makings

An important step in managing the crisis is the degree of commitment to decision-making and the timeliness of this process. Decisions made at time of crisis should be made by consensus and make sure that a complete democratic yet pace keeping leadership style is used. All decisions made during times of crisis are guided by a set of principles:

All decisions must abide by standards of equity and are very well calibrated

All decisions should be taken near your students and faculty

Make sure that your thoughts and decisions are made with an eye set outside the university walls as the decisions taken in the time of crisis are affected and affect the world around the university

Both consistency and coordination are the cornerstone to proper, in-time decision-making

It is important to act with urgency and make sure you keep the time lines but also make sure you have a perspective and a vision that sets itself to the postcrisis era and not just to overcome the crisis.[8]

Utilize resources to respond to faculty, administration, and student needs

Define and plan for the logistical needs (extra requirements such as providing internet access to the low-income students, allow free internet packages for the junior staff, etc.)

Ultimate use of available resources of the Faculty and the same university with the aid of the student support groups; both at national level or at the level of the university[1]

Provide the safety measures for the clinical staff, residents, interns, alumni, and clinical-year students

Provide the updated guidelines from the ministry of health and the WHO

Training staff members

Provide technical support for the staff members and the students' coordinators.

Resolve emerging conflicts

In times of crisis, conflicts will arise due to several factors many of which are related to the feeling of insecurity. Conflicts also arise when roles and expectations are not clear. Conflict resolution is the responsibility of the conflict resolution team and should be done timely and without delay. It is inadvisable to overlook any minor conflicts.

Expect conflicts and communicate this with your team at an early stage

Embrace conflict understanding that conflict could add to the richness of the proposed solutions and are a gateway to open meaningful discussions

Listen carefully to opposing views and evaluate the perception of your colleagues

Communicate the vision and make sure you get buy in from all sides of the conflict

Find solution and offer alternatives bearing in mind conflict management grid.

Support for institutional well-being

Understand the true nature of the crisis and make sure you understand the impact and potential pressures that exist on your faculty, administration, and students. Students at medical schools have scored up to 30% prevalence in suicidal ideation in some studies.[9] This puts a lot of emphasis on the importance of mentorship and close follow up of our students during the crisis.

Supporting the mental health of students and faculty who suffer from isolation, blurred vision, fears, and difficult family situations is essential.

Communicate with the psychiatry support team and announce contacts of the psychiatry team for psychological support for the students and staff

Provide online awareness sessions for mental health that are uploaded

Organizing online informal meetings with the Coordinators for psychological support and answering the students' queries

Regular online office hours for academic support and to keep in touch with the students.

Appreciate the best practice

At times of crisis, it is important to celebrate best practices and identify principles that work best. Celebration in times of crisis should not be held solely in relevance to milestones or deliverables. The morale of the team should be the first priority when making celebratory decisions. As we say, catch your team doing something well and celebrate it on any given occasion.

Documentation of the best practice by staff members

Encourage sharing the experience through educational videos, or fast track publications

Documentation of students' best practice, by appreciation certificates

Encourage the engagement of students in documenting the best practice through creating videos or sharing their perception and reflection to webinars, meetings, and publications.[10]

Be aware of your own needs

Being in a position of responsibility makes you prone to pressure, and all types of health issues that are related to stress. Make a practice out of checking in with yourself every day to make sure that you acknowledge your negative feelings and are perceptive of your physical and psychological needs. Create a coalition of supporters around you and make sure you are in connection with them daily. Having people around you who know you and your capacities well is very important to help you realize when it is that you need support the most [Table 2].

Table 2

Daily checklist for leaders during crisis management

Checklist
Have you checked in with the disaster response team today?
Have you revised the media message for today?
Have you checked your Gantt chart and identified necessary executive steps?
How satisfied are your students today? How different are they feeling from yesterday and why? Is there anything you can do to make diffuse and situation that emerged?
What is the status of well-being of your institution? Who needs support? Is there anything you can do to make the status of well-being better?
What decisions need to be made today? How will they affect the stakeholders? Will you be able to defend these decisions once you make them?
Is there any conflict emerging today? What will your directions be to the conflict resolution committee?
Have you identified good practices for today? How will you celebrate them?
Have you checked in with yourself? How are you feeling? What kind of support do you need?

Document for the future

The collective brains of institutions grow and develop with experience.[11] The challenge that exists in every experience is an added value for the traditional depth of wisdom that exists in the institutional decision-making capacity. Amid crisis, make sure that your institution has developed a strategy to document the roots of decisions made throughout it. Documentation through filing has long been the practice of choice. We propose a more robust documentation process where all processes are documented together with the root cause for each decision. This can be done through timely appreciative interviews with decision makers and videotaping the experience. At the end a documentary of all decisions and how they were made can be made together with an institutional reflective practice on their perception of the crisis response.

CONCLUSIONS

We need to make the best use of the current COVID-19 situation in raising institutional readiness for crisis management in the future. This paper offers tips for medical education institutions that could be of help [Table 2].

Highlights

Managing higher education institutions regarding crisis require a new set of skills

There are twelve areas to focus during crisis

It is recommended to use a daily checklist to follow-up the work stream.

Ethics statement

Ethical approval was not required as this article is an opinion piece, based on the authors' experience.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.